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Memory disorders centers provide specialized care

Clinics at the University of Miami and Mount Sinai in Miami Beach are among 15 in the state that offer a multi-disciplinary approach to diagnosing and treating patients suffering from Alzheimer’s and other memory issues.

For eight years, Nelida Siriana watched her husband Miguel’s mental and emotional health steadily deteriorate. Initially diagnosed with depression and anxiety, the once-active retiree grew listless. He became aggressive and entertained suicidal thoughts.

At wit’s end, the West Kendall woman decided to take him to the University of Miami’s Memory Disorder Center. After a battery of tests, Dr. Elizabeth Crocco, a geriatric psychiatrist, diagnosed Miguel, 78, with lewy body dementia, the second-most-common type of progressive dementia after Alzheimer's disease. Lewy body leads to unusual behavior, including significant fluctuations in alertness and attention, and rigid muscles, slowed movement and tremors.

His medication was changed and he began visiting the center every two months. “He’s back more to being like himself,” Siriana says. “The change has been spectacular. If we had gone on with the old way, we wouldn’t have gotten anywhere.”

The Siriana case is one example why memory disorder clinics, staffed by highly trained specialists and researchers, can be best suited to evaluate, treat and research Alzheimer’s disease and other memory problems.

“Other physicians can diagnose, but we offer a multidisciplinary approach that best serves the patient, the family and caregiver,” says Crocco, who is also co-director of the UM center.

There are 15 memory disorder clinics in the state, two of them in Miami-Dade alone — UM’s and the Wein Center for Alzheimer’s Disease and Memory Disorders at Mount Sinai Medical Center in Miami Beach. Both the UM and Mount Sinai centers are partly supported by the Florida Department of Elder Affairs.And while improved diagnostic tools allow psychiatrists and other physicians to diagnose, the centers offer a more-comprehensive approach to treatment. “The individual physician doesn’t always understand the full scope of the disease,” says Wien director Dr. Ranjan Duara. “They focus on the evaluation. But Alzheimer’s and other disorders are very complex. It’s not just cognition but also behaviors, all those aspects of the disease that are not always addressed.”

Both the UM and Wien clinics were among only four centers launched back in 1986 with some funding from the Florida Legislature. The other two were at the University of Florida and the University of South Florida.

“Since then,” says Duara, “the numbers [of people with Alzheimer’s and memory disorders] has increased dramatically, more than doubling in Florida. At the same time the scope of what we do has widened.”

The two memory disorder centers provide a layered approach to diagnosis and treatment. They incorporate psychiatry, geriatrics, counseling, social support, diagnostic imaging and referrals to available community resources. Center directors like to boast that they focus attention not only on the patient but also on the beleaguered caregiver.

For good reason. More than 5 million Americans suffer from Alzheimer’s alone and one in three Americans will die of it or another dementia, according to the Alzheimer’s Association. This means that in 2013, 15.5 million caregivers provided an estimated 17.7 billion hours of unpaid care valued at more than $220 billion.

It is estimated that this year alone memory disorders will rack up $150 billion in costs to Medicare and Medicaid. In fact, nearly one in five dollars spent by Medicare is on Alzheimer’s or some other kind of dementia. Projections say it will only get worse. Barring any breakthroughs to stop the disease, by 2050 the number of people age 65 and older with Alzheimer's disease may nearly triple, from 5 million to as many as 16 million.

Though treatment can slow the progress, no cure has been found for Alzheimer’s, the disease that accounts for about 80 percent of all dementia cases. Duara and Crocco, however, offer hope. “Over the past 25 years we have had a huge growth in [diagnostic] tests alone, in imaging devices we can use,” Duara adds. “There are many trails going on now as well.”

That is an added benefit of seeking help at a memory disorder center, where psychiatrists, geriatricians and social workers have access to cutting edge research. As do other centers, both UM and the Wien Center conduct clinical trials that may prove to be a breakthrough in the treatment or prevention of the disease.

Duara and his team, for example, are participating in The Anti-Amyloid Treatment in Asymptomatic Alzheimers's study — known as A4 — which will study cognitively normal elderly individuals and test them for amyloid plaques in the brain. Those who test negative for these plaques will continue in the study as a control group. Those who test positive will be assigned at random to receive a placebo or an investigational drug, a once-a-month infusion of an antibody that targets amyloid and rids the brain of these plaques, a hallmark of Alzheimer's brains.

The study hopes to find out whether decreasing amyloid with antibody treatment can slow the memory loss associated with amyloid buildup.

At the University of Miami's Miller School of Medicine, a professor in the department of neurology, which partners with the memory disorder center, is focusing on neurons, the nerve cells that carry information from one cell to another. Alzheimer's disrupts the process of cell communication by killing neurons and damaging the brain's communication network.

UM also opened a Brain Fitness Pavilion earlier this year, where mind-game software approved by the Food and Drug Administration is used to enhance cognitive functions for healthy people and those with mild cognitive impairment.

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